Could hormonal remission in prolactinomas be achieved with surgery? Our experience
Objective. To determine the factors that lead to sustained hormonal remission in patients with pituitary adenomas.
Material and methods. In this study, retrospective analysis of 33 patients with pituitary adenomas with no prior DA treatment was performed. Ten (30.3 %) patients experienced microprolactinomas, 19 (57.6 %) — macroprolactinomas, 4 (12.1 %) — giant prolactinomas. All patients underwent endoscopic endonasal transsphenoidal surgery. Plasma PRL levels were obtained before surgery, and then 1 day, 1 week, 1 month, 3 months later and every 6th month after surgery. MRI monitoring was performed before surgery and then 3 and 12 months later, and then annually.
Results. Average preoperative plasma PRL serum levels for all patients with no preoperative DA treatment were 530 ng/mL (ranging 65–1440 ng/mL). Cavernous sinus invasion (Knosp 3, Knosp 4) was observed in 16 (48.4 %) cases. Depending on cavernous sinus invasion, hormonal remission with no DA therapy after surgery was achieved in Knosp 0–2 — in 16 (94.1 %) cases, Knosp 3 — in 4 (44.4 %) cases. In cases of Knosp 4 biochemical remission was not achieved in all 7 (100 %) patients. Only with further DA therapy biochemical remission was achieved. The biochemical remission was achieved in 10 (100 %) cases of microadenomas, in 7 (58.3 %) cases of macroadenomas after surgery with no DA therapy. Remission of endocrine symptoms was achieved in 18 (81.8 %) cases with no DA therapy after surgery. The follow-up was up to 3 years.
Conclusions. Biochemical remission could be surgically achieved in 100 % of cases with microprolactinomas. In cases of macroprolactinomas the adenoma size (up to 24 mm) has an important role in achieving biochemical remission. Cavernous sinus invasion (Knosp 0–2) is a prognostic factor. The ophthalmic disturbances regression in macro and giant pituitary adenomas was found to be achieved much faster in surgical management rather than using DA.
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